Say what?

"According to my notes from Dr. Hayes, you are neurotic, yes?"

Ok, I wasn't expecting to hear those words.  "Neurotic" doesn't sound good, rhymes with "psychotic", and besides, why is this new psychologist making such pronouncements when he is first getting to know me?  Well, because that's what he's paid to do, I suppose.  So I went home and looked up the definition.

Neurosis:  a relatively mild mental illness that is not caused by organic disease, involving symptoms of stress (depression, anxiety, obsessive behavior, hypochondria) but not a radical loss of touch with reality (which would be psychotic) .

What I also found out was that this is a general category that is no longer in widespread use by the psychiatric community.  There are some things I agree with, other things I don't.  I've never lost touch with reality.  That I agree with.  "Mild mental illness"?  When one is so depressed that getting off the couch is a challenge, that suicide seems reasonable, one would not describe that as "relatively mild".  "Not caused by organic disease?"  My understanding of being bipolar is that it is indeed organic, having to do with certain imbalances in the chemistry of one's brain, and not just a symptom of stress.

So, I'll talk with the doctor about his next time.

Mental health diagnosis is often, it seems, a judgment call.  Psychiatrists and psychologists often argue amongst themselves.  Some are more prone to certain diagnoses, others see such conditions as much less common.  I'm confident in my diagnosis of Bipolar Disorder.  The reason is that my depression did not respond to antidepressants, but did respond to mood stabilizers.  Bingo.  That's Bipolar.

But even within that, Bipolar I or II remains a judgment call.  It has to do with the degree to which one has experienced manic episodes.  What are the symptoms?

"In order for a manic episode to be diagnosed, three (3) or more of the following symptoms must be present:

• Inflated self-esteem or grandiosity
• Decreased need for sleep (e.g., one feels rested after only 3 hours of sleep)
• More talkative than usual or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing
• Attention is easily drawn to unimportant or irrelevant items
• Increase in goal-directed activity (either socially, at work or school; or sexually) or psychomotor agitation
• Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)"

There are other less technical associations, such as being delusional, or losing touch with reality, but that's not actually on the list.  Though "inflated" is a bit out of touch with reality.  As is "grandiosity".  

One of the struggles with an exact diagnosis is that during a manic episode one feels good and often doesn't seek help, though others may recognize that things are getting out of control if they know what to look for.  My last manic episode was shortly after going through chemical dependency treatment.  I resigned my call and went into business, spending about $60,000 in the process, I took over my therapy sessions and had my psychologist simply listen as I did my 'fifth step', etc.  My feeling great at that time was credited in part to the 'blue cloud' of recovery, of getting my life back on track, etc.  And the diagnosis of being Bipolar had not yet been made.  Had my health team been looking for signs of mania, they would have recognized it.  Bottom line, one of the difficulties in making an exact diagnosis is that they have not directly witnessed a full blown manic episode.  

But also, I believe, is the fact that the difference between mania and hypomania is really a matter of degree and not type.  

"You're somewhat egotistical."  That was also in the notes.  Truth is that depends on whether I'm in a manic phase or a depressed phase.  When I'm manic, I'm prone to believe I'm one of the best pastors in the ELCA.  On the other hand, when depressed I feel like a total failure, and that everything was for naught.  To an extent, both beliefs are delusional.  Out of touch with reality?  Well, yes, I'm neither the best nor the worst.  Reality is somewhere in between that.  

I look forward to working with a new therapist.  Maybe some new insights will be helpful.  Among other things he talks more.  And maybe I need to listen more.  

No referral needed

"I'll be retiring March 31st."  "You are doing just fine."

These were the words of my psychologist this month.  His retirement is welcome for him, though he admitted to some ambivalence.  He will miss the intimacy of his therapeutic relationships.  And it signals for me a milestone.  What he did not say was that we'd need to get me referred to another therapist.  He reflected on all his notes from the last year, and remarked how stable I'd been and affirmed that I'm in a healthy place.  No referral necessary.  I'm good to go.  It's time to fly solo.

I admit to some ambivalence.  The professional intimacy of a therapeutic relationship is a friendship of sorts that is rare.  It is not an overstatement to say that there is no one else on the face of this earth that knows more about me.  He has probed with me the depths of my soul and psyche and throughout it all has been an affirming, challenging, and healing presence.  But now there will be one more session, and closure.  It's time to fly solo.

I will continue seeing my psychiatrist.  This is necessary because of the medication regimen I am on.  So flying solo isn't totally alone.  And should I need it, I will trust her to refer me to another therapist.

For now though, no referral is needed.

I admit to feeling a bit like a kid, learning to ride a bike, who realizes that dad has let go and is no longer balancing the bike.  You know the feeling.  Simultaneously crying out "wait, don't let go!" but also being thrilled to realize that you are riding on your own.

When my disability benefits terminated I had similar emotions.  The process of termination was, in my opinion, cruel, without warning, and could have been handled much better.  And with the termination of benefits came the loss of the safety net that had sustained us through the tough times. But, there was also a positive.  Their evaluation was that I was no longer disabled.  You are good to return to the workforce.

And then there is a part of me that feels the need to cry out to the world "I'm OK!"

Part of the stigma of dealing with a mental illness diagnosis is that concerns linger.  So the insurance company determines I'm no longer disabled in any way.  My therapist determines that I'm healthy and do not need any further therapy.  But what about the world?  What about my family?  What about the Church?

For the last five years I've been out of the fire, so to speak.  For the purposes of my healing I've been sheltered in relatively low stress situations.  An unanswered question is whether the state of my health is such that I can engage again in more challenging situations without compromising everything that has been achieved.  Yet the fear of relapse can itself be disabling.  But it is only a fear.  And I hear the voice of Jesus say "Fear not, for I am with you."

Some clarity is emerging.  I know what I want.  I want to complete my years in my vocation serving to the full extent of my abilities.  I do not want to simply fade away.  I do not want to be restricted to semi-retirement until I can fully retire.  The bottom line is I'm probably healthier now than I've ever been, and I crave the opportunity to serve on that basis.

Yet there is another dimension.  To accept life on life's terms.  I do not know what life will offer me.  The fact is that even if I had been totally healthy up to now, I'm 61 years old.  There is age discrimination.  I may envision working till I'm 70, but many employers would view me as a shortimer.  It may be that my desire to reenter the workforce, that my hopes to cap off my career with a challenging and rewarding call, maybe thwarted by the two strikes against me, my age, and my history of mental illness.  That may be the reality.  I think that if it is so, its unfortunate.  But life is not always fair.

Confidence.  Health is one issue.  Confidence is another.  So my psychologist has determined that I'm in a healthy place.  He is confident in my ability.  Am I?  And have I been stable enough, long enough, that others are confident too?

If someone is cancer free for five years, or so, a degree of confidence emerges.  One might even dare say that one is 'cured'.  One may also stop thinking of oneself as a cancer patient and start thinking of oneself as a survivor.

I wonder if I'll ever experience that as one with a mental health diagnosis.

My official diagnosis regarding my chemical dependency is "in remission".  Is that a status the world will allow regarding being bipolar.

My son is a chemical engineer.  One of the things he points out is there is no difference chemically, between man made compounds and natural compounds.  Chemistry is chemistry.

So I am healthy today.  What that means is that the chemistry within my brain is balanced.  For me that is achieved through medication.  But chemistry is chemistry.  That I have the correct balance in chemicals in my brain is all that really matters.  What doesn't matter is whether that occurs 'naturally', or through medication.  Chemistry is chemistry.

I find hope in that.  And regardless what life throws at me, I know I'm in a better place to deal with it.  Yes, I wonder what the future holds for me, vocationally.  Too soon to tell for sure.  So I tend to the task at hand.  One of the things I do to find meaning and purpose is to write.  Many of you read this because of our friendship.  But I actually don't write for you.  I have received feedback from others who are bipolar, or who deal with other mental health issues, that has affirmed what I am doing as being genuinely helpful for them.  And so I see this as a calling.

Perhaps, writing from a place of health and wellbeing after having negotiated through the tough times of being mentally ill is the higher calling that I have.  I offer it up as hope for those still in the throws of the disease.  I didn't die.  It hasn't destroyed me.  And the fears associated with it were not real, they were just emotions.  Hope.